INCB7839 in Treating Children With Recurrent/Progressive High-Grade Gliomas

A Phase I Study of the Adam-10 Inhibitor, INCB7839 in Children With Recurrent/Progressive High-Grade Gliomas to Target Microenvironmental Neuroligin-3

This is a multicenter phase 1 trial of INCB7839 for children with recurrent or progressive high-grade gliomas, including, but not limited to, diffuse intrinsic pontine glioma (DIPG) and other diffuse midline gliomas (DMGs), after upfront therapy.

Study Overview

• Status: Completed
• Conditions: Glioblastoma Multiforme; Anaplastic Astrocytoma; Anaplastic Oligodendroglioma; DIPG; High-grade Astrocytoma NOS; CNS Primary Tumor, NOS (Malignant Glioma)
• Intervention / Treatment: Drug: INCB7839

Detailed Description

INCB7839 is an inhibitor of the ADAM (A Disintegrin and Metalloprotease) 10 and 17 proteases. Neuronal activity regulates glioma growth through neuroligin-3 (NLGN3). ADAM 10 is the protease responsible for NLGN3 release into the tumor microenvironment and represents a promising therapeutic target.

Pre-clinical studies of INCB7839 in patient-derived pediatric high-grade gliomas (GBM and DIPG) revealed that INCB7839 inhibits pediatric high- grade glioma growth and improves overall survival. In vivo testing also demonstrated that INCB7839 penetrates brain tissue sufficient to achieve its pharmacodynamic effect of ADAM10 inhibition. Further pre-clinical studies in other animals revealed minimal toxicity, including non-adverse to mild increases in serum hepatobiliary enzymes, protein, calcium, cholesterol values, along with minimal decreases in RBC mass parameters; all parameters recovered.

INCB7839 has been evaluated in Phase I and Phase II clinical trials for previously treated solid tumors and breast cancer. Of the adverse events (AEs) noted, the majority were mild-to-moderate in severity, the most frequent being fatigue, nausea, anorexia, diarrhea, emesis, abdominal pain, anemia and constipation. The dose-limiting toxicity for monotherapy with INCB7839 in Phase I clinical trials was declared to be deep venous thrombosis (DVT). Out of 41 patients, there was a total of 9 thrombotic events including mild superficial thrombophlebitis (n=1), DVT (n=4), vena cava thrombosis with renal insufficiency in a patient with squamous cell cancer of the head and neck (n=1), atrial thrombosis in patient with breast cancer (n=1), and pulmonary embolism in patients with hormone-refractory prostate cancer (n=2). Overall, INCB7839 does exhibit a pro-coagulant effect in some adult patients, resulting in an increased incidence of DVT, whether used alone or in combination. The mechanism of this effect is unknown, and there is no clear relationship between the frequency of thrombosis and the dose administered.

• Study Type: Interventional
• Enrollment (Actual): 13
• Phase: Phase 1

Contacts and Locations

Study Locations

• United States
  • California
    • Los Angeles, California, United States, 90026
      • Children's Hospital Los Angeles
    • Palo Alto, California, United States, 94304
      • Stanford University and Lucile Packard Children's Hospital
  • Colorado
    • Aurora, Colorado, United States, 80045
      • Children's Hospital Colorado
  • District of Columbia
    • Washington D.C., District of Columbia, United States, 20010
      • Children's National Medical Center
  • Illinois
    • Chicago, Illinois, United States, 60614
      • Ann & Robert H. Lurie Children's Hospital of Chicago
  • Massachusetts
    • Boston, Massachusetts, United States, 02245
      • Dana Farber Cancer Institute
  • New York
    • New York, New York, United States, 10065
      • Memorial Sloan Kettering Cancer Center
  • Ohio
    • Cincinnati, Ohio, United States, 45229
      • Cincinnati Children Hospital Medical Center
  • Pennsylvania
    • Pittsburgh, Pennsylvania, United States, 15224
      • Children Hospital of Pittsburgh
  • Tennessee
    • Memphis, Tennessee, United States, 38105
      • St. Jude Children's Research Hospital
  • Texas
    • Houston, Texas, United States, 77030
      • Texas Children's Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 3 years to 21 years (Child, Adult)
• Accepts Healthy Volunteers: No

Description

INCLUSION CRITERIA:

Histologic diagnosis:

• Patients with recurrent/progressive high-grade gliomas, as defined by progressive neurologic abnormalities or worsening neurologic status not explained by causes unrelated to tumor progression (e.g., anticonvulsant or corticosteroid wean, electrolyte disturbances, sepsis, hyperglycemia, etc.), OR a ≥ 25% increase in the bi-dimensional measurement, taking as a reference the smallest disease measurement recorded since diagnosis utilizing the MRI sequence best demonstrating tumor, OR the appearance of a new/metastatic tumor lesion(s) since diagnosis.
• Eligible diagnoses include but are not limited to the following: diffuse intrinsic pontine glioma (DIPG), H3K27M-altered diffuse midline glioma (DMG), glioblastoma multiforme, anaplastic astrocytoma and anaplastic oligodendroglioma. Spinal cord tumors are eligible with pathologic confirmation of the above.
• Please note: Patients with a radiographically typical DIPG at diagnosis, defined as a tumor with a pontine epicenter and diffuse involvement of more than 2/3 of the pons, are eligible without histologic confirmation.
• Patients with pontine lesions that do not meet these radiographic criteria will be eligible if there is histologic confirmation of pontine glioma WHO II-IV.
• Patients with diffuse or multi-focal disease are eligible; patients with leptomeningeal spread are eligible.

Age

• Patients must be ≥ 3 but ≤ 21 years of age at the time of enrollment.

BSA

• Patients must have a BSA ≥ 0.70-2.50 m2 for dose 120 mg/m2/dose BID.
• Patients must have a BSA ≥ 0.55-2.80 m2 for dose 80 mg/m2/dose BID (Patients who have BSA 0.55-1.00 m2 will only receive 100 mg AM dose).

Ability to Swallow

• Patients must be able to swallow tablets whole.

Measurable disease

• Patients must have measurable disease in two dimensions on MRI to be eligible.

Prior Therapy

• Patients must have failed at least 1 standard, tumor-directed treatment besides surgery and recovered from the acute treatment-related toxicities (defined as < Grade 1) of all prior chemotherapy, immunotherapy, or radiotherapy prior to enrollment on this study.

• Patients must be ≥ 28 days from any prior surgery at the time of study enrollment (with the exception of minor dental and dermatological procedures).

  • Chemotherapy

• Patients must have received their last dose of known myelosuppressive anticancer therapy at least 21 days prior to enrollment or at least 42 days if nitrosourea.

  • Investigational/ Biologic Agent
• Biologic or investigational agent (anti-neoplastic): Patients must have recovered from any acute toxicity potentially related to the agent and received their last dose of the investigational or biologic agent ≥ 7 days prior to study enrollment.
• For agents that have known adverse events occurring beyond 7 days after administration, this period must be extended beyond the time during which adverse events are known to occur.
• Monoclonal antibody treatment and agents with known prolonged half-lives: Patients must have recovered from any acute toxicity potentially related to the agent and received their last dose of the agent ≥ 28 days prior to study enrollment.

• Immunotherapies: Patients who have received checkpoint inhibitors or other immunotherapies with a known potential for pseudoprogression and who have assumed tumor progression must be at least 12 weeks from prior immunotherapy AND have at least two MRI scans at least 4 weeks apart demonstrating further progression OR have a biopsy to confirm tumor progression OR have new site(s) of disease.

  • Radiation

Patients must have had their last fraction of:

• Craniospinal irradiation, whole brain radiation, total body irradiation or radiation to ≥ 50% of pelvis or spine ≥ 42 days prior to enrollment.
• Focal irradiation ≥ 14 days prior to enrollment.
• Local palliative irradiation to site other than primary tumor progression site ≥ 14 days prior to enrollment.
• Stem Cell Transplant

Patients must be:

• ≥ 6 months since allogeneic stem cell transplant prior to enrollment with no evidence of active graft vs. host disease.
• ≥ 3 months since autologous stem cell transplant prior to enrollment.

Neurologic Status

• Patients with neurological deficits should have deficits that are stable for a minimum of 7 days prior to enrollment.
• Patients with seizure disorders may be enrolled if seizures are well controlled.

Performance Status

• Karnofsky Performance Scale (KPS for > 16 years of age) or Lansky Performance Score (LPS for ≤ 16 years of age) assessed within two weeks of enrollment must be ≥ 50.

Organ Function: Patients must have adequate organ and marrow function as defined below:

• Absolute neutrophil count ≥ 1.0 x 10^9 cells/ L
• Platelets > 100 x 10^9 cells/ L (unsupported, defined as no platelet transfusion within 7 days)
• Hemoglobin ≥ 8 g/dL (may receive transfusions)
• Total bilirubin ≤ 1.5 times institutional upper limit of normal (ULN)
• ALT (SGPT) and AST (SGOT) < 3 x institutional upper limit of normal (ULN)
• Albumin ≥ 2 g/dL
• Serum creatinine based on age/gender as noted in institutional normal range. Patients that are not within institutional normal range but have a 24-hour Creatinine Clearance or GFR (radioisotope or iothalamate) ≥ 70 mL/min/1.73 m^2 are eligible.

Corticosteroids

• Patients who are receiving dexamethasone must be on a stable or decreasing dose for at least 7 days prior to enrollment.

Growth Factors

• Patients must be off all colony-forming growth factor(s) for at least 7 days prior to enrollment (e.g., filgrastim, sargramostim or erythropoietin). Fourteen (14) days must have elapsed if patient received a long-acting formulation.

Pregnancy Prevention

• Patients of childbearing or child fathering potential must be willing to use a medically acceptable form of birth control, which includes abstinence, while being treated on this study.

Informed Consent

• The patient or parent/guardian is able to understand the consent and is willing to sign a written informed consent document according to institutional guidelines.

HIV Positive Patients

• HIV-positive patients are eligible if the following criteria are met:

  • Stable on their antiretroviral agents
  • Have CD4 counts above 400/mm^3
  • Undetectable viral loads, and
  • No need for prophylactic medications for an opportunistic infections

EXCLUSION CRITERIA:

Pregnancy or Breast-feeding

• Pregnant women or nursing mothers are excluded from this study. Female patients of childbearing potential must have a negative serum or urine pregnancy test within 72 hours prior to receiving the first dose of study medication. If the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required.

  • Pregnant or breast-feeding women are excluded from this study due to risks of fetal and teratogenic adverse events as seen in animal studies.

Concurrent Illness

• Patients with any clinically significant unrelated systemic illness (e.g., serious infections or significant cardiac, pulmonary, hepatic or other organ dysfunction), that in the opinion of the investigator would compromise the patient's ability to tolerate protocol therapy, put them at additional risk for toxicity or would interfere with the study procedures or results.
• Patients with any other current malignancy.

• Patients with uncontrolled hypertension (i.e., a blood pressure (BP) > 95th percentile for age, height, and gender; patients with values above these levels must have their blood pressure controlled with medication prior to starting study drug).

  • The normal blood pressure by height, age, and gender tables can be accessed in the Generic Forms section of the PBTC member's webpage.
  • Patients who are ≥ 18 years of age must have blood pressure that is < 140/90 mm of Hg at the time of registration.

Concomitant Medications

• Patients who are receiving any other anti-cancer, investigational or alternative (e.g., cannabinoids) drug therapy are ineligible.

Prisoners

• Prisoners will be excluded from this study.

Inability to participate

• Patients who in the opinion of the investigator are unwilling or unable to return for required follow-up visits or obtain follow-up studies required to assess toxicity to therapy or to adhere to drug administration plan, other study procedures and study restrictions.

Allergy

• Patients with a history of allergic reactions attributed to compounds of similar chemical or biologic composition.
• Patients with a history of allergy to pork products due to contraindications with low molecular weight heparin (LMWH).

Thrombosis Risk

• Patients with a known coagulopathy or bleeding disorder (e.g., von Willebrands disease) are not eligible.
• Patients with a history of non-central line related thrombosis or disorders that promote clotting (e.g., anti-thrombin III deficiency, Lupus anticoagulant) are not eligible.
• Significant family history of thrombosis (i.e. deep venous thrombosis or pulmonary embolus) in a first-degree relatives (i.e., parents or siblings) are not eligible.
• Estrogen containing contraceptives are not permitted due to thrombotic risk. Progestin-only contraception along with alternate forms of contraception are acceptable.
• Patients should be counseled to avoid smoking/tobacco products.
• If there is any contraindication to DVT prophylaxis, the patient is not eligible.

Family history must be documented to the best extent it is known.

Subjects with current or prior symptomatic intratumoral or intracranial hemorrhage are ineligible.

Subjects with asymptomatic evidence of new CNS hemorrhage of more than punctate size (i.e., ≥ 4 mm) and/or more than one punctate focus of hemorrhage (< 4 mm or not seen on more than one slice) on baseline MRI obtained within 14 days prior to study enrollment are ineligible.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Dose-finding; INCB7839 dosing will begin at 120 mg/m2/dose BID which is equivalent to the adult RP2D (200 mg PO BID) based on a typical adult size of 1.67m2. The INCB7839 dose may be decreased to 80 mg/m2/dose BID if the staring dose is not tolerable. 28 consecutive days (4 weeks) will constitute one course. Patients may continue to receive INCB7839 for 26 courses (approximately 2 years).

Drug: INCB7839; INCB7839 dosing will begin at 120 mg/m2/dose BID which is equivalent to the adult RP2D (200 mg PO BID) based on a typical adult size of 1.67m2. The INCB7839 dose may be decreased to 80 mg/m2/dose BID if the staring dose is not tolerable. 28 consecutive days (4 weeks) will constitute one course. Patients may continue to receive INCB7839 for 26 courses (approximately 2 years).

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of Patients Who Experienced Dose-limiting Toxicities (DLTs)	All subjects evaluable for dose-finding were classified as having DLT or not having DLT, and the number of subjects having DLT was reported. Any INCB7839-related adverse events during the first course of treatment that led to dose reduction, permanent cessation of therapy, or a delay in treatment of >7 days were considered DLTs. Hematologic DLTs included any grade 4 hematologic toxicity except lymphopenia; grade 3 neutropenia with fever; or requiring a platelet transfusion on 2 separate days during a single course. Non-hematologic DLTs included any grade 4 non-hematologic toxicity; any grade 3 non-hematologic toxicities with some exceptions such as grade 3 fever or infection of fewer than 5 days in duration; any grade 2 non-hematologic toxicity persisting for >7 days and considered medically significant; and any deep venous thrombotic event (superficial phlebitis was excluded unless grade 3 or 4 or unless it met another criteria for DLT).	Approximately 28 days
Maximum Tolerated Dose (MTD) and/or Recommend Phase II Dose (RP2D) of INCB7839	A design similar to the Rolling-6 design was used and 6 slots were initially opened on the starting dose level (dose level 1, INCB7839 120 mg/m^2/dose BID). If no more than one dose-limiting toxicity (DLT) was observed in these 6 subjects, we would expand this cohort to at least 12 patients for additional safety and pharmacokinetic information. If more than 3 DLTs were observed in 12 subjects at dose level 1, then the initially identified maximum tolerated dose based on 6 subjects would be considered unsafe and de-escalation to a lower dose level (INCB7839 80 mg/m^2/dose BID) would be considered.	Approximately 28 days
Area Under the Curve (AUC) of INCB7839	Pharmacokinetic (PK) studies were performed after an oral INCB7839 dose on days 1, 2, and 3 of Course 1. Beginning day 1 of Course 1, INCB7839 serial blood PK samples were drawn pre-dose and at approximately 1, 4, 8, 24, and 48 hours after the first dose. Time points at which data were collected to create the curve were 0, 1, 4, 8, 24 and 48 hours post-dose. The area under the curve (AUC) was estimated using a noncompartmental method.	Up to 3 days after the start of treatment
Maximum Concentration [Cmax] of INCB7839	Pharmacokinetic (PK) studies were performed after an oral INCB7839 dose on days 1, 2, and 3 of Course 1. Beginning day 1 of Course 1, INCB7839 serial blood PK samples were drawn pre-dose and at approximately 1, 4, 8, 24, and 48 hours after the first dose. Time points at which data were collected were 0, 1, 4, 8, 24 and 48 hours post-dose. The maximum concentration (Cmax) was estimated using a noncompartmental method.	Up to 3 days after the start of treatment
Apparent Oral Clearance [CL/F] of INCB7839	Pharmacokinetic (PK) studies were performed after an oral INCB7839 dose on days 1, 2, and 3 of Course 1. Beginning day 1 of Course 1, INCB7839 serial blood PK samples were drawn pre-dose and at approximately 1, 4, 8, 24, and 48 hours after the first dose. Time points at which data were collected were 0, 1, 4, 8, 24 and 48 hours post-dose. Clearance (CL/F) was estimated using a noncompartmental method.	Up to 3 days after the start of treatment
Time to Reach Maximum Concentration [Tmax] of INCB7839	Pharmacokinetic (PK) studies were performed after an oral INCB7839 dose on days 1, 2, and 3 of Course 1. Beginning day 1 of Course 1, INCB7839 serial blood PK samples were drawn pre-dose and at approximately 1, 4, 8, 24, and 48 hours after the first dose. Time points at which data were collected were 0, 1, 4, 8, 24 and 48 hours post-dose. The time to reach maximum concentration (Tmax) was estimated using a noncompartmental method.	Up to 3 days after the start of treatment

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percent Probability of Progression-free Survival	Progression-free survival (PFS) was defined as the time interval from date of treatment start to date of first event (progressive disease or death due to any cause) for patients with events, or to the date of last follow-up for patients without events. PFS was estimated using the method of Kaplan and Meier and reported with a 95% confidence interval. We had planned to report the 2-year PFS estimate, but the 2-year estimate was not defined as most subjects progressed prior to 2 years. The 3-month PFS estimate was reported. All subjects are off study and data collection has concluded for this outcome measure.	3 months from first dose of INCB7839
Percent Probability of Overall Survival	Overall survival (OS) was defined as the time interval from date of treatment initiation to date of death due to any cause or to the date of last follow-up for survivors. OS was estimated using the method of Kaplan and Meier and reported with a 95% confidence interval. All subjects are off study and data collection has concluded for this outcome measure.	3 months from first dose of INCB7839
Duration of Response	Complete or partial responses were considered responses. Response was evaluated by imaging or clinical progression. Duration of response was measured from the time measurement criteria were met for complete or partial response until the first date that recurrent or progressive disease was objectively documented.	Up to 2 years following last dose of INCB7839

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
ADAM10 Inhibition of HER2	HER2 extracellular domain (ECD) in serum will be reported.	Baseline and Day 14 of Course 1
ADAM10 Inhibition of Neuroligin-3 (NLGN3)	Descriptive statistics for neuroligin-3 (NLGN3) in cerebral spinal fluid will be reported.	Up to 30 days post treatment.
Maximum Concentration [CMAX] of INCB7839 in Cerebrospinal Fluid	The maximum concentration [CMAX] will be calculated based on the cerebrospinal fluid pharmacokinetic samples.	Up to 30 days post treatment

Collaborators and Investigators

• Sponsor: Pediatric Brain Tumor Consortium
• Collaborators: National Cancer Institute (NCI); American Lebanese Syrian Associated Charities
• Investigators: Study Chair: Michelle Monje, MD, PhD, Stanford University and Lucile Packard Children's Hospital

Study record dates

Study Major Dates

• Study Start (Actual): July 27, 2020
• Primary Completion (Actual): December 31, 2023
• Study Completion (Actual): December 1, 2024

Study Registration Dates

• First Submitted: February 27, 2020
• First Submitted That Met QC Criteria: March 2, 2020
• First Posted (Actual): March 4, 2020

Study Record Updates

• Last Update Posted (Actual): January 5, 2026
• Last Update Submitted That Met QC Criteria: December 12, 2025
• Last Verified: December 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Neoplasms; Neoplasms by Histologic Type; Digestive System Diseases; Gastrointestinal Diseases; Stomach Diseases; Neoplasms, Glandular and Epithelial; Neoplasms, Neuroepithelial; Neuroectodermal Tumors; Neoplasms, Germ Cell and Embryonal; Neoplasms, Nerve Tissue; Pyloric Stenosis; Gastric Outlet Obstruction; Glioblastoma; Glioma; Astrocytoma; Oligodendroglioma; Pyloric Stenosis, Hypertrophic
• Other Study ID Numbers: PBTC-056 (Other Identifier: CTEP); UM1CA081457 (U.S. NIH Grant/Contract); NCI-2019-08964 (Registry Identifier: CTRP (Clinical Trial Reporting Program))

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No